Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Correlation between optical coherence tomography angiography macular parameters with optical coherence tomography structural parameters in primary open angle glaucoma (a longitudinal descriptive study)

Background: There is growing evidence indicating that glaucoma pathogenesis is attributed to vascular dysfunction.Aim: compare the macular circulation in normal individuals and glaucomatous patients in the superficial as well as the deep retinal plexuses, to determine and characterize macular circulation deficits in glaucoma along with correlating them with structural macular OCT parameters Methods: descriptive study included 100 eyes of 100 participants who were selected randomly from attendants of ophthalmology outpatient clinic in Beni-suef university hospital Participants were subjected to 24-2 SITA- standard automated VF test using SAP ,OCT ONH examination and OCTA (Macula)  Results: IOP showed significant negative moderate to strong linear correlation with all the Macular Parameters in Glaucoma Participants. These correlations were highly significant; (p-values <0.001). All measurements of superficial and deep macular venues plexuses by studied macular OCTA was statistically significantly lower in glaucomatous as compared to non-glaucomatous participants; (p-values <0.001). Conclusion: There was a reduction in VD in particular that of superficial layer in POAG patients in macular region, according to OCTA measurements. Glaucomatous eyes have a significantly sparser superficial VD in the macula when compared to healthy eyes, and these VD assessments are significantly accompanied by the severity of VF destruction and OCT structural affection